1. در مرکز پزشکی هسته ای دکتر دباغ – دکتر صادقی
در خدمت شما هستیم
مشهد، ملاصدرا 11 ، پلاک 1/4
Tel:+98(51) ; +98(51)

2. Nuclear Medicine in Parathyroid Gland
a brief review
V. R. Dabbagh Kakhki, M.D.
Nuclear Medicine Specialist
Associate Professor
DSNMC
Nuclear Medicine Research Center (NMRC; MUMS)

4. Primary Hyperparathyroidism
Experienced hands:
Successful removal of hyperfuntiononing thyroid tissue: 85-95%
Most: Bilateral neck exploration without pre-operative localization:
>75%: more extensive surgical procedure than is necessary
From 1990: no recommendation preoperative localization but for recurrent or persistent PHPTH
Gradual shift toward preoperative localization before initial surgery.
75% now
Avoid bilateral exploration: limited exploration
Decrease operative time
Identify ectopic glands
Cost effective: 23.5% reduction in cost

5. Radiopharmaceutical Selenium-75 selenomethionine Tl-201
Tc99m Sestamibi (choice)
Tc99m Tetrofosmine
Subtraction imaging with:
Tc99m pertecnetate and Tl-201
thyroid thyroid and parathyroid

6. Tc99m-Sestamibi Parathyroid Imaging
Patient preparation: None
Tracer : Tc99m-Sestamibi, 20 mCi, IV
Time of imaging: Early scan: 15 min
Delayed scan: 2 hr
Views : ANT, LAO , RAO ( 300 k) planar
SPECT may also be a consideration

9. Tc99m-Sestamibi Parathyroid Scan
Detection of adenoma
Sensitivity: 81%-95%
Specificity>95%
PPV:97%
MIBI Uptake:
Adenoma size
Function: PTH or Ca
Proportion of oxyphil cells
False Positive: Nodular goiter

10. Tc99m-Sestamibi Parathyroid Scan
Hyperplasic tissue
Sensitivity: <70%
Specificity and PPV>90%

11. Tc99m-Sestamibi Parathyroid Scan
SPECT:
Increase detection rate
Better localization
Intraoperative gamma probe:
Reducing the likelihood of persistent or recurrent disease
Radioguided minimally invasive parathyroidectomy

12. Persistent or recurrent PHPTH
5-15%
Compromise localization:
Distorted normal tissue planes
Increased likelihood of ectopic glands, multigland and supernumerary glands
Success rate at reoperation: 60-62%
Tc99m-Sestamibi: neck and mediastinum
Specially SPECT

18. V.R.Dabbagh; DSNMC; www.DSNMC.ir